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It can be extremely difficult to get an insurance company to cover the costs of continuous glucose monitoring (CGM) systems. The excuses that these holdout insurance companies provide as to why they don’t want to cover CGM are becoming less justifiable thanks to research and advancements in the way we think about the needs of people living with diabetes. This is why I am a Diabetes Advocate.

So far in 2014, I have only been able to get four Dexcom continuous glucose monitor sensors out of my health insurance company. Four sensors is a one month supply. It is now July. That means for five months out of this year (so far) I have not been able to wear my CGM or benefit from the data that it gives me and the alarms that it uses to tell me when my blood sugar is dropping too low or rising too high. Each time I try to get more CGM sensors, I have to restart the approval process with my insurance company, spend weeks going back and forth between Dexcom, my endo, and insurance trying to get all of the documentation together to submit for approval, just to be denied because either Dexcom isn’t a preferred provider, or because the insurance company has decided that there isn’t enough evidence to support that CGM is a benefit and results in better control of diabetes. So then I appeal. And I know there are many, many other people struggling with getting CGM coverage by their health insurance just like I am.

This is also why I am a medical librarian. Challenge accepted, health insurance industry. Bring it on.

The most dangerous side effect of insulin is hypoglycemia, or risk of dangerous low blood sugars. The ability of CGM systems to alarm and notify a person with diabetes is one of the most valuable and beneficial advances in diabetes technology ever. EVER. The fact that there are small devices now that can warn us, as if to say, “Hey dude, your blood sugar is dropping. It might be a good idea to get a snack or something,” is incredible. This is an incredible benefit to people with diabetes so that they don’t get in a dangerous situation with a low blood sugar that can leave them incapacitated, unconscious, or possibly even dead if it happens in the middle of the night while they are asleep. Do you know how health insurance companies make money off of a dead person with diabetes? They don’t.

CGM technology benefits insurance companies too. It is incredibly cheaper to provide the technology that will alarm and cue someone to get a sandwich, a juice box, or a Level gel to get their blood sugar up on an ongoing basis than it is to pay for home or work visits by paramedics, rides in the back of an ambulance, hours in an emergency room, and likely overnight stays in the hospital depending on the severity of the lows. A low blood sugar can happen at any time, and is usually unpredictable based on varying amounts of food, activity, stress, varying absorption rates of body tissue from one spot to the next, and any other factor in life that can cause any amount of change. Sometimes they happen for seemingly no reason at all, and therein lies the danger.

…the one with early analysis of cost-effectiveness of CGM that says…well, I’ll just let is speak for itself. “…the overall quality-of-life effect of CGM arises from its ability to both improve the immediate quality of life of diabetic patients as well as reduce future complications through enhanced glycemic management.” But wait, there’s more! “The provision of greater glucose control data may have improved the quality of life of patients by facilitating decisions related to food intake and insulin regimens as well as by reducing the risks and fears of hypoglycemia.”

This is only a start. There is more research out there, and more research on the way that shows the benefits of CGM on the lives of people who use insulin to manage their diabetes. It is time for health insurance companies to get with the program, and it is time for us to speak up and shout from the rooftops what we need, and make it happen. Some health insurance companies are better than others (PPOs tend to be more willing to cover CGM than HMOs, for example). Until coverage of CGM is non-negotiable, our work as advocates for our own health and well-being is not done. We should not have to beg and plead to get this widely accepted diabetes technology that has already been and continues to be proven to improve and save lives. Coverage of CGM should be non-negotiable, expected, and mandatory.

Now that we are staring down the barrel of the potential for the bionic pancreas in a few more years, the need for CGM acceptance by insurance companies is only going to grow. Without insurance companies accepting that CGM is indeed a good idea for people with diabetes, and without insurance companies making CGM technology accessible without the barriers and complicated processes of getting approval, and without more research documenting the cost benefits and effectiveness of CGM versus emergency responses to hypoglycemic episodes (low BGs), the bionic pancreas will never make it past the prototype phase. And we need this forthcoming technology that the bionic pancreas, and the research behind it, provides.

I’m tired. I’m so very tired. I’m tired of living every single day and running every decision that I make through a diabetes filter. I’m tired of having to prick my finger before I leave for work in the morning to make sure that my blood sugar level is okay for me to be able to drive. I’m tired of checking before meetings to make sure that my blood sugar isn’t dropping, for no other reason than so that I don’t get caught in the middle of a meeting not making sense because my blood sugar dropped too low. I’m tired of having to check before I put any bite of food in my mouth, and then having to check an hour or two after to see if that food and the insulin that I took to cover it worked the way that I thought it would. Sometimes it does, and sometimes it doesn’t. Most of the time it defies explanation. I’m tired of having to decide if I get to go to the gym and workout today based on what my blood sugar is right before I go. I’m tired of having to check so that I can drive home. I’m tired of having to check before I can go to bed. I’m tired of not being able to go to bed because I did check, and having to wait for my blood sugar to go up or come down.

I’m tired. I’m tired of the hassle. I’m tired of the bullshit. I use that word because that is just how tired of it I am. I don’t have pipedreams of a cure for diabetes. I’ve had diabetes for 33 years. It’s all I know, and all I have ever had to deal with, and I don’t walk around with imaginary hope that a cure is coming in five years, ten years, or even necessarily in my lifetime. I hope it does. Maybe it will, but short of a scientific breakthrough, I don’t feel like that is the best place for me to invest my energy. In this age of technological advancements, this age full of the smartest people that have ever lived on this planet, and this age where people are open to change and progress and opportunity, I want to be able to rest my mind when it comes to diabetes. Let’s work together to support things like the bionic pancreas, CGM coverage by insurance companies, and these things that simply make life with diabetes easier and better.

I don’t feel like making life easier with diabetes is really asking too much. If you think it is, then you try it. See if you can make it 33 years counting fingerpricks, carbohydrates, activity levels, insulin doses, times you’ve found yourself in a room waking up and not knowing where you are because of a severe low blood sugar, a tongue chewed up from a low blood sugar seizure, bruises that you don’t know how you got, and cracked ribs from the physical exertion of just trying to survive that low. Survive that, and then I dare you to tell me how CGM isn’t effective and isn’t necessary.

I double arrows down dare you.

Update, 7/30/2014:
I am so fortunate to have received a few sensors from other PWD who had the extras to spare. Thank you! You know who you are, and you have been a big help (he types, as he is recovering from a BG of 39 and still a little shaky). I received a call from Dexcom this afternoon, confirming that they finally got all of the pieces that they needed with insurance approval and documentation from my endo, and they are overnighting me new sensors. Yay! It took 7 months, which is ridiculous, but people with diabetes are experts at being stubborn and steadfast until we get what we need (*cough* bionic pancreas *cough* encapsulation *cough* smart insulin). So thankful that it appears to have finally been worked out. Ciao for now! (Did I really just type “Ciao for now!”? I must still be low…)

Update, 8/21/2014:Order got delayed, again, before it could be shipped to me. Today I finally received a 90-day supply of Dexcom sensors, allegedly with auto-renew when I need more. Still not clear on what took so long, aside from the explanation from my Dexcom rep that it was dramatically delayed by all of the authorizations required in order for insurance to approve. I’d demand more of an explanation, but it’s been a long battle, and I’m tired. Glad to finally have CGM data again, even if it did take 8 months longer than it should have.

At first, I was thinking that I would toss out this post, or save it for later, in order to respond to the news from the Diabetes Research Institute. I know that a post like this, full of words on a screen, risks getting lost in the mix. But maybe it won’t.

If you read my last post, you know that A-Flizzle surprised me with a birthday trip to Jacksonville to tour the Budweiser brewery, hang out with Jacquie and the gang, get a massage, and go to one of my favorite restaurants in the whole wide world called 13 Gypsies. And my blood sugar spiked sky high. So now you’re caught up. As Paul Harvey would say, this is “the rest of the story.”

I’ve been sitting on this post for a few weeks now. It’s been a really hard thing for me to share. It’s the post I’ve been waiting to write for, like, 23 days.

My blood sugar was sky high, but I couldn’t very well call in diabetic and cancel a quality birthday celebration. Nor did I want to. I bolused for the high, but having been unplugged from my pump for as long as I was, there was really no telling how much insulin it would take to turn things around and get my BG’s back to normal. I knew I would need to feather the insulin over time in small doses so that I didn’t get a big ball of insulin hitting me all at once. It sounded like a good idea, at least. Until it just wasn’t working. Not even a little bit. Not even at all.

So, I did what any abnormal person with a nonfunctioning pancreas would do in the situation: I rage bolused the $h!t out of that high to show it who was boss. And I did too.

Later that night, after we had gone out to a rooftop bar and then to one of our favorite hangouts in 5 Points, Birdie’s, A-Flizzle and I trekked back to our hotel to call it a night. We settled in, I stretched out on the bed, propped my head up on a stack of pillows, and started watching one of the greatest movies of all time that just happened to be on TV that night: Con Air. What? You know you love it!

A-Flizzle was sound asleep, and I was laying there in bed messing around with my iPad and watching Cyrus the Virus battle The Man of Nomadic Eyebrows from the Land of Forgotten Forehead (aka, Nicholas Cage) for a shot at freedom via a crash landing on the Las Vegas strip (don’t blame me, I didn’t write it) when it hit me. Hard. And I remember every single part of it.

In an instant, I had absolutely no clue where I was. I couldn’t figure out what I was doing, even though I was doing nothing. I couldn’t think. I couldn’t concentrate. I couldn’t help overanalyzing every next thought that was popping into my head, and I had no control of what was popping into my head next.

I sat up and threw my legs over the side of the bed. My bare feet hit the cold wooden floor. I sat there, in a complete panic, trying to figure out what was going on. I knew what was going on. I just couldn’t quite figure out what was going on. But everything was so serious. I couldn’t figure out what was happening, what was next, what I should do.

I stood up. I walked over to my BG kit, and sat it on the table. I walked off. I started pacing around the room, stomping hard, trying to figure out what in the world was going on. I could see A-Flizzle in the middle of the king size bed, sound asleep. I tried to yell for her, but I couldn’t. No sound would come out. I started hitting my diabetes tattoo, indicating, trying to make noise and get her attention. Anybody’s attention. But it wasn’t loud enough.

And that’s when it hit me: I was low. Really, really low. And I was standing in the room with the one person that I trust more than anyone, and I could not for the life of me (literally) figure out how to get her attention. What would be so simple any other time, to simply yell or reach out and shake her awake, I could not figure out how to tell my body to do. I just knew that this was really, really serious, and I had to figure out something through my garbled thoughts.

I paced around the king sized bed like a tiger walking a perimeter, establishing his territory. Back and forth, from one side to the other, for I don’t even know how long. All the while I’m trying to figure out how to wake her up. I was fading. The panic was wearing me out. I was starting to think about what A-Flizzle would do without me, and how much it would crush her to lose me when she was right there, so close. What would happen to my Hopper (dog), Squirt (cat), and Bindi (A-Flizzle’s dog) back home without me. How their little hearts would break when I didn’t come home from a weekend away. How my Hopper would continue to look for me at the door long after Amanda got home, just waiting on me to get there to give him a doggie hug.

All I could think was, “This might be the one. That one low blood sugar that I don’t survive. The big one.” I was also thinking, “Dammit, I don’t want to go to the hospital on my friggin’ birthday!” I started punching the corner of the bed because I was so frustrated that I couldn’t get my body and brain to communicate and work properly. Then I thought of big ones, like the big earthquake in California that everybody always talks of but hasn’t happened yet. The hurricane that will come and sink Florida. The importance of having an emergency plan, a parachute. A parachute? A PARACHUTE! For when I fall!

I managed to figure out that if I passed out from the low, it was my pump that would continue to give me insulin and keep me low. I snatched it from my PJ pants pocket, and unhooked it, not bothering to suspend it, and threw it on the bed. I went over to my bag, and found the glowing bright red rectangle that contained glucagon, and held it tight in my left hand. I knew that if I passed out, A-Flizzle would likely hear me hit the floor, and hopefully see the glucagon in my hand and know what to do. If she didn’t, at least my pump was off, so hopefully I would survive long enough for my blood sugar to come back up naturally before…well, before I died.

As I was digging in my bag for that, I uncovered a Level gel. I ripped off the top with my teeth and managed to get most of the gel in my mouth through the lack of motor skills and shaking that I didn’t realize was happening. Once I got the Level gel in me, and gave it time to work, I was finally able to figure out how to reach over and wake A-Flizzle up to help me. By then I was back on the edge of the bed, drenched in sweat, shaking, still holding the glucagon case in my left hand, and completely physically and emotionally exhausted. Half asleep, her training that I taught her in case I ever go low kicked in, and she was able to retrieve two more Level gels and help me get them down before I had to lay down, else pass out from exhaustion. Still, I wasn’t up to a normal and safe BG level yet.

A-Flizzle set a timer on her phone to wake us up every 15 minutes for me to test my BG again. After an hour of that, I was still only at 70. Not too low, but certainly not high enough to go to sleep after such a bad low. I took one more Level gel, and then I was out for the rest of the night. I woke up the next morning at 96. Normal. And completely hungLOWver, worn out, physically and emotionally exhausted from the night before.

I’m thankful that I taught A-Flizzle what to do when I go low. I’m thankful that we have a plan and always know where things are to treat a low, even if half asleep. It’s so important to have something available to treat a low blood sugar, and know where it is even in your subconscious. That is what may save you in the event that you have to build your own parachute. I know it did me. It’s been extremely hard for me to admit to myself, but I know that I wouldn’t be here right now had I not had those gels, known where they were, and the fact that they were easy for me to get into when it was literally life or death for me.

Tomorrow, the DRI is set to share some big news about steps toward an eventual cure for diabetes. I really hope it is everything that we hope it will be. I’d be lying though if I didn’t admit I’m skeptical. Don’t confuse that with negativity. I’m positive that there will be a cure someday, and I’ll be the first one to celebrate tomorrow if there is something to celebrate. I’ve just heard that a cure was coming since my mother was told that there would be one when I was diagnosed at age two, 32 years ago. A cure for diabetes is exactly what every one of us with diabetes, and every parent of a child with diabetes, wants in this world. Nobody should have to see their life flash before their eyes on their birthday because of a low blood sugar like I had to. However, hoping and praying and wishing doesn’t get us closer to that day.

I’ve learned to keep myself grounded in reality. Maybe that’s a defense mechanism so that I’m not constantly let down, but experience says to be patient, diligent, and steadfast today so that we can make it to tomorrow. The absolute best thing we can do is take care of ourselves today, support each other in the diabetes community, both online and offline, and not let our fellow person with diabetes stumble. You can do this, and so can I. Then, when that cure does arrive, whether it’s tomorrow or twenty years from now, we’ll be ready.

For this (sort of) Wordless Wednesday, I bring you the live tweeting and photo adventure of getting a diabetes tattoo. Big ups to Matt Manning at Monument Tattoos in Tallahassee, Florida for listening to what I was looking for and translating that into a wicked awesome piece of body art with a practical purpose. One of my low blood sugar tells is that I sometimes lose the ability to talk and communicate properly. This is especially problematic when I need to get someone’s attention and make them aware that I need a little help. The idea behind a diabetes tattoo was that it would be something that is always on me, and I could hopefully indicate (e.g., point to it, gesture at it, hit someone over the head with it) in the event that I need some assistance. And it would look awesome as sh**. Your diabetes may vary.

National Health Blog Post Month, Day 18: A comment as a blog post. Pick someone else’s post (from the past or from today) and write a comment to them. Write that comment as your blog post for today. Link back to them to let them know you were inspired.

Yesterday, I was reading through the “Let It Be” themed blog posts, and one really stuck out to me. Jen, over at Blood, Sweat & Carbs, wrote about the fear that so many parents have when raising a child with Type 1 diabetes. Jen’s words are real, and vivid, and I know something that every single parent of a child with diabetes thinks about, but never wants to admit. For some reason, Jen’s fear reminded me of a story that I haven’t thought about in awhile.

One morning in my early 20’s, I woke up all alone, in a strange bed, cold, in a room well lit with fluorescent lights, covered with nothing but a thin sheet, wearing only a pair of shorts, and staring at the clock on the wall above the door, trying my best to figure out when and where in the world I was. Turned out I was in the emergency room, having had a severe low blood sugar and seizure early that morning.

My dad would always call me in the mornings when he was working off the coast of Louisiana on oil rigs, and he later said that I had answered the call, but then he heard a crack and the phone went dead. The crack was my head hitting the kitchen floor. My girlfriend at the time heard the commotion, found me in the floor, and called 911.

After the ambulance ride and whatever the doctors did in the ER to get me back to good, my girlfriend and my college roommate finally invaded my room in the ER after having been told to wait in the lobby for a time. It wasn’t long before my mom and grandma, who lived an hour and a half away, also showed up. I remember being happy to tears that they were all there, and that I wasn’t alone anymore. Hospitals are scary when you’re that low. Heck, the entire world is scary when you’re that low.

It was still relatively early morning when I was discharged from the ER. I was starving, so we all went to McDonald’s to get breakfast. And who doesn’t love McDonald’s breakfast? No one. It’s awesome. Anyway…

While we were in line, a homeless man asked my mom if she could spare a few dollars so that he could get some breakfast. Thankful that I was okay, and in the spirit of blessings, my mom didn’t hesitate to give the man a bit of the cash for him to get himself some food with. The disheveled man promptly took the money and headed for the door, where his friend was waiting, so that they could most likely go buy themselves some booze instead.

Seeing this, my mom marched after him and grabbed him by the collar before he could get out the door and told him, “Now, I gave you money because you were hungry and wanted breakfast, and I just picked up my son from the hospital and we are thankful to be alive this morning. I didn’t give you money to go blow it on booze and cigarettes.” She then proceeded to walk the man to the counter at McDonald’s, as if he was a six year old boy, and made him order breakfast for him and his friend. Then she took her change back and sent them on their way with a paper bag full of hot McDonald’s goodness.

Back where me, my girlfriend, and my grandma were sitting, we couldn’t stop laughing at the spectacle of my mom making this bum unexpectedly order him and his friend breakfast. To this day, that story that started out so frightening still brings a smile to my face.

I don’t know why Jen’s post made me think of it. Maybe just to illustrate that diabetes is what it is, and it is going to throw a curveball in the direction of all of us at some point. The key is to be ready, and to be thankful for all the times that diabetes doesn’t win, which hopefully far outnumber the more fearful moments. Remember that, as a parent, it is your reaction to diabetes that your child will remember and learn to mimic, and will carry with them through life.

And also, never give a bum money at McDonald’s. Walk him to the counter and make him order breakfast instead. (Thanks Mom!)

Me and Mom (2006)

This post was written as part of National Health Blog Post Month (NHBPM) – 30 health posts in 30 days: http://bit.ly/vU0g9J

While trying to figure out a good topic to write a blog post about while enjoying a giant cup of coffee at a nearby Starbucks, I spied with my two eyes a table of three police officers who were on break. I recently read a great blog post by my buddy Scott Johnson titled “Cops and Low Blood Sugars” about a conversation he had recently with a couple of officers about traffic stops involving diabetes and low blood sugars. Feeling curious, I decided to follow Scott’s lead, so I grabbed my blog business cards and headed over to the table o’ police and asked if I might be able to interrupt them for a few minutes. To my surprise, they were very polite and happy to accommodate me, and invited me to sit down and join them.

These particular three officers worked traffic duty with the Tallahassee Police Department. One of them had also worked for a time with the Florida Highway Patrol. The former FHP officer was the most vocal of the group, and seemed to have had the most experience encountering diabetes behind the wheel.

I started with the same question that Scott did, inquiring if they had encountered traffic stops involving diabetes and low blood sugars. The former FHP officer said yes, and proceeded to share a couple of the more extreme cases he had dealt with. One story involved a man who was having a low blood sugar while driving on I-95 near Jacksonville into oncoming traffic. The officer said that he had to force the driver into the guardrail on the side of the highway to stop his car and keep him from injuring someone in a potential head on collision. Another story involved a PWD behind the wheel who was having a diabetic seizure and crashed into a tree.

I proceeded to ask the officers how they distinguish a diabetic medical emergency from driving while intoxicated (DWI). The short answer, they don’t. At least, not initially. A low blood sugar and a DWI can cause such similar behavior that stopping the vehicle and getting the driver away from the wheel in the name of public safety is of the highest priority to the police officers. There was a lot of head nodding at that statement, so they appeared to be in agreement on this point.

The officers said that they can sometimes distinguish a diabetic medical emergency from a DWI based on smell. Two of them described a sweet odor that comes off of a PWD when they are having a severe low, as opposed to the pungent smell of alcohol. I’m guessing what they are describing is the odor from the clothes-soaking sweat that sometimes accompanies a sudden low. Still, I’m not going to bank all of my points on an officer being able to help me based on smell alone. What if that officer has a cold on that one day that I need his sniffer to be fully functioning to save my life? To my relief, they also acknowledged other typical low blood sugar symptoms including confusion, sweating, inability to focus or respond to basic questions, shakiness, and in extreme situations even seizures, vomiting, and loss of consciousness. I gave them a mental check mark for knowing those.

So what happens, after the car is stopped and everybody is safe? If it is a diabetic medical emergency, the officers confirmed that paramedics would be called. After that, they said to fully expect the applicable punishments according to law. Read: citations and possible suspension of driving privileges until review and approval for reinstatement by the medical review board. They informed me that the steps that a PWD would have to go through after such an event would likely be similar to those that someone who suffers from epilepsy would have to go through to get their license or have their license reinstated, including a period of time (unspecified how long, and probably varies by situation or state) showing that their diabetes is in good control. Still, they deferred to the medical review board, as once the traffic case is closed, they are often left out of the loop as to what exactly happens in the long term.

From their no-nonsense point of view (and the one point where we disagreed), having a low blood sugar behind the wheel of a car and driving drunk are both totally preventable and are entirely the choice of the driver. One officer said that it is person’s choice whether or not they want to take responsibility for their diabetes and keep it under control, no different than a person’s choice to drink alcohol before they get behind the wheel of a car.

Obviously, he didn’t have diabetes. Nobody’s perfect. *wink*

We know that the realities of living with diabetes are not necessarily preventable or predictable. Life happens. Still, rather than argue, I encouraged the officer to continue, because I wanted him to understand that I’m asking for a HUGE number of people who live with diabetes each and every day. I want to make his job and our lives both easier in the unfortunate event that we do find ourselves on the side of the road having to deal with each other. What can we do, as PWD’s, to help police officers help us in a time of need?

Wear a medical alert ID on your wrist.

All three police officers acknowledged that recognizing a medical alert bracelet on the wrist or around the neck of a person is part of their training. They even followed up by saying that the wrist is the first place they would look, since they are trained to make sure they can see a driver’s hands at all times.

I also inquired about bumper stickers or window decals that say “Diabetic Driver.” They all said that it might help, but a medical ID on the wrist would be better. In a traffic stop, they are trained to look for other things beyond what a bumper sticker or window decal says, and a medical ID on the driver is more indicative that they are indeed the person in need of attention.

Get your drivers license to indicate that you have diabetes or are insulin dependent.

In Florida, if you indicate that you have Type 1 diabetes you can get a stamp on our license that says “INSULIN DEP” in bright red letters. I actually took my license out and showed it to the officers, and they said that because that is the only red ink on the entire license, it stands out and they will notice it. They also said that sometimes (unfortunately, not 100% of the time) the dispatch officer will also point out to them when they run the license number that this is a person who is insulin dependent and may need assistance. Check with your state to see what your options are. (I’d also be curious to know if there are any options like this for those with Type 2 diabetes.)

Check your blood sugar EVERY time before you get behind the wheel of a car.

The officers (and me) all agreed that managing diabetes is the most important thing we can do before getting behind the wheel of a car. Before you drive anywhere, stop and take 30 seconds to check your blood sugar, and if necessary treat accordingly. Let’s be honest, you probably need to check it anyway.

10-10-10:10 THINGS for you to take 10 MINUTES to share with 10 PEOPLE about your diabetes.

#1That you have diabetes.
If you aren’t comfortable sharing it with a group, share it with just one person at a time. A friend, coworker, or roommate is a great start. You may need them one day, and awareness is in both of your best interests should that need arise.

#2What type diabetes you have.
Each different type of diabetes requires a different set of rules and things to be aware of. An easy talking point is to share what type diabetes you have, and how it compares to others. It’s also always fun to baffle people with your expert knowledge that yes, you can indeed get “juvenile diabetes” (Type 1) as an adult. Mind blowing! Because it takes so much of our attention to manage our own diabetes, check the ADA web site if you need help educating yourself on the various types of diabetes.

#3Your story.
Every one of us has a collection of diabetes stories. People can most identify with what you went through when you were diagnosed. Some of us, like me, were far too young to remember, but maybe your parents or loved ones passed these stories down to you. If not, share how your life has changed pre- and post-diagnosis. I have found that most people are very impressed by how much us diabetics know about our bodies. Toot your own horn!

#4How you manage your diabetes.
Some of us use an insulin pump, continuous glucose monitoring (CGM), multiple daily injections (MDI), and hopefully all of us with diet and exercise. Share the tools and tricks of the diabetes management trade that work for you. You don’t have to go into the nitty gritty details, but sharing that you know what you’re talking about and how to manage your diabetes goes a long way into the comfort levels of all involved in being able to talk about it openly. I like to show off my insulin pump and BG meter when I am sharing, and curiosity usually gets the cats to talking. This is also when I like to point out that I can eat the same foods as everyone else, as long as I know my BG and count carbs. This goes a long way in warding off the Diabetes Police.

#5The difference between a low and high blood sugar for YOU.
Although this can dance on the edge of being clinical, it’s something that most non-diabetics don’t know. Try to put into words what it feels like when you have a high or low BG. For example, when I am high, it feels like my blood has turned to molasses, and doing anything is like trying to do it while submerged in Jell-O. Most people can appreciate that description, unless they’ve never had Jell-O. And if that is the case, you get to make a new friend tomorrow by bringing them a Jell-O cup. I suggest Sugar Free Lime or Strawberry Banana.

#6Symptoms of a low blood sugar.
As scary as a low BG can be, this is quite possibly the hardest part of the “I have diabetes…” conversation, because it is 100% serious REAL LIFE when it happens. Describe a low blood sugar in your own words, and include those symptoms that are most common to you and your diabetes. We’re not all the same. If, like me, you’re prone to nonsensical motor mouth as a symptom of a low BG, share that. Then, if you’re talking too much and annoying your friend, at least they have an out by suggesting that you go check you’re blood sugar so you’ll shut up. Winner, winner.

#7How to treat a low blood sugar.
Share the important details, such as where you keep your glucose or Glucagon hidden, and that insulin does NOT make your blood sugar go up. I don’t know why so many people think that insulin makes blood sugar go up, but they do. Educate them. Let people know what works best for you to treat a low BG. If juice is your go to low BG fix-it-all, then tell them that, and where they can find it. Your life may depend on it, and it will reduce panic if you need an extra bit of help.

#8Your medic alert identification.
Point out where it is, whether it is a bracelet, necklace, wallet card, or other form of medic alert. I have had diabetes nearly my entire life, and am as guilty as anyone of not wearing my medic alert ID like I should. So, dig it out of your underwear drawer (or jewelry box, if you’re a girl) and put the thing on. If you don’t have one, go buy one. No excuses. I’ll even guilt you into it: Don’t put the people around you in the position of having to answer a paramedic’s medical questions about you in the event of an emergency. Emergency personnel are trained to look for medical alert ID’s, so get after it.

#9What you can do despite diabetes.
I think it is so important to let people know that diabetes is NOT a death sentence. It is so very far from a life ending condition, and as long as we manage it successfully, we can do anything that anyone else can. Thanks to modern technology and medicine, we can play sports, have a family, and even be a celebrity. We are only limited by our own imagination. Diabetes only holds us back as much as we allow it to, which coincidentally means that us people with diabetes (PWDs) are notoriously stubborn. I think that’s a side effect we can live with.

Being an adult who is self-admittedly too independent for my own good, a cyclist, and quite simply a PWD who is out and about in the world, it makes sense that I get a medic alert ID and wear it as religiously as I do my yellow LIVESTRONG bracelet.

Having read posts like Sarah’s “Three Year Present” and coming from the perspective of maintaining my independence as much as possible when it comes to my health and well-being, I’m now on the prowl for a medic alert that fits my style.

But what do I really need? How much info do I need to be available via my medic alert bracelet? Do I really have so much medical information that I need a 2GB USB drive integrated into my medic alert? Do I need a subscription service like that offered by the MedicAlert Foundation, where my ID has a unique number on it that links to additional information about me should it be needed? Or can I get away with just the basics about my diabetes and allergies with a simple engraving on the back?

And what do I want? There are so many options compared to the simplicity of when I was a kid and wore a medic alert bracelet or necklace. I could never keep up with the bracelet that just said “Diabetes” on it. It was cheap and would always break and disappear into the oblivion and wonder that is a school playground. The necklace charm worked better as a kid, but now that I’m an adult, I’m not really a necklace person. I don’t need anything bringing attention to my big round head anymore than necessary. Can I find a bracelet that fits my rebellious, edgy, rockstar, non-conformist style while not totally ruining the times when I need to err on the side of dressing professional? I do get paid to be a librarian, after all.

I have two Road ID‘s that I wear while cycling that are so well worn that the information on them is barely legible anymore (not to mention outdated and inaccurate, aside from me still being a T1 Diabetic, which hasn’t changed in 29 years). I need something that’s going to hold up with time…and oil changes, or whatever mess I get into.

Maybe I should get a tattoo. I’ve wanted a tattoo for awhile now, but haven’t found something that I’m so passionate about that I feel the need to get it inked onto my body. As a dblogger and d-advocate, does my passion for the education about and better treatments for diabetes, plus my own health, meet the passion threshold to merit getting a tattoo? My girlfriend’s dad says that “A tattoo is a permanent reminder of a temporary state of mind.” I tend to agree, but my diabetes isn’t going anywhere, and if it does, I would gladly live with a permanent tattoo of when I USED to have diabetes.

Alisha Wilkes's diabetes tattoo, which I think is pretty much AWESOME!

Decisions, decisions.

The key here is that all of us PWDs should wear our medic alerts in some way, shape, or form. Paramedics and emergency personnel are trained to look for them, and it is in our personal best interest to still be able to communicate with them, even if we are physically unable to. Low BG’s can sneak up on those who are in the very best control. It’s diabetes, it happens. We feel guilty about it afterward, like it is our fault, as if we caused it. However, I would much prefer to be around to feel that way, than to not be around because the person that found me had no idea that I have special needs.

So yes, you do indeed need a medic alert ID. So do I. Now where did I put my wallet?